Introduction
Routine Blood Collections represents the most heavily tested and fundamentally important domain on the National Healthcare Association (NHA) Certified Phlebotomy Technician (CPT) examination, comprising 30% of the total exam content with 30 scored questions out of 100. This domain encompasses the core technical skills that define phlebotomy practice, including venipuncture techniques, capillary collections, equipment selection and assembly, proper order of draw, antiseptic application, specimen labeling, and post-procedure patient care. Mastery of routine blood collection procedures is absolutely essential not only for exam success but for safe, effective practice as a certified phlebotomy technician in hospitals, laboratories, clinics, and other healthcare settings. The questions in this domain test your ability to perform everyday blood collection tasks with precision, ensuring patient safety while maintaining specimen integrity for accurate laboratory results. Your competence in routine collections directly impacts patient care quality, as improper technique can lead to hemolysis, contamination, patient injury, or the need for recollection, causing patient discomfort and healthcare delays. The emphasis on this domain reflects the reality that routine blood collections constitute the majority of a phlebotomy technician’s daily responsibilities, making these skills the foundation of professional practice. Understanding proper tourniquet application, needle insertion angles, tube inversion requirements, and complication management will serve you throughout your career while demonstrating the technical proficiency employers expect from certified professionals. The clinical skills you develop in this area directly translate to improved patient outcomes, reduced collection errors, and enhanced laboratory efficiency. Success in this domain requires both theoretical knowledge and practical application, as you must understand not just what to do, but why specific techniques are used and how to adapt when complications arise. This comprehensive preparation in routine blood collections will position you for success on the NHA CPT exam and in your future role as a skilled healthcare professional.
Practice Questions
Question 1: What is the correct angle for needle insertion during venipuncture?
- 5-10 degrees
- 15-30 degrees
- 45-60 degrees
- 90 degrees
Correct Answer: B) 15-30 degrees
Explanation: The optimal needle insertion angle for venipuncture is 15-30 degrees. This angle allows for smooth entry into the vein while minimizing patient discomfort and reducing the risk of going through the vein or causing hematoma formation. A shallower angle may cause the needle to slide along the skin surface, while a steeper angle increases the risk of puncturing through the vein.
Question 2: What is the maximum time a tourniquet should remain on a patient’s arm?
- 30 seconds
- 1 minute
- 2 minutes
- 5 minutes
Correct Answer: B) 1 minute
Explanation: A tourniquet should not remain on the patient’s arm for more than 1 minute to prevent hemoconcentration, which can alter test results by increasing the concentration of proteins, cells, and other analytes. If the draw takes longer than 1 minute, the tourniquet should be released and reapplied after allowing circulation to return to normal.
Question 3: Which tube should be drawn FIRST in the standard order of draw?
- Red top (no additive)
- Light blue top (sodium citrate)
- Lavender top (EDTA)
- Blood culture bottles
Correct Answer: D) Blood culture bottles
Explanation: Blood culture bottles are always drawn first in the order of draw to minimize the risk of contamination from other tube additives or the needle. This is critical because contaminated blood cultures can lead to false positive results, inappropriate antibiotic therapy, and extended hospital stays. The sterile collection technique for blood cultures takes priority over all other specimens.
Question 4: How many times should a tube containing EDTA be inverted after collection?
- 3-4 times
- 5-6 times
- 8-10 times
- 15-20 times
Correct Answer: C) 8-10 times
Explanation: Tubes containing EDTA (typically lavender top tubes used for hematology tests) should be inverted 8-10 times immediately after collection to ensure proper mixing of the anticoagulant with the blood. This prevents clot formation and ensures accurate cell counts. Under-mixing can lead to microclots, while over-mixing can cause hemolysis.
Question 5: What is the most appropriate action if a patient faints during blood collection?
- Continue the procedure quickly
- Remove the needle, lower the patient’s head, and apply a cold compress
- Shake the patient to wake them up
- Leave the patient alone and get help
Correct Answer: B) Remove the needle, lower the patient’s head, and apply a cold compress
Explanation: If a patient faints during blood collection, immediately remove the needle and apply pressure to the puncture site, lower the patient’s head below heart level or have them lie down, loosen tight clothing, and apply a cold compress to the forehead or back of the neck. This promotes blood flow to the brain and helps the patient recover. Never leave a fainting patient unattended.
Question 6: Which vein is typically the FIRST choice for venipuncture?
- Basilic vein
- Cephalic vein
- Median cubital vein
- Hand veins
Correct Answer: C) Median cubital vein
Explanation: The median cubital vein in the antecubital fossa is the first choice for venipuncture because it is typically large, well-anchored, close to the surface, and has fewer nerve endings nearby, making it less painful for the patient. It also has a lower risk of rolling or collapsing compared to other veins in the arm.
Question 7: What should be done if blood stops flowing during venipuncture?
- Push the needle deeper
- Withdraw the needle completely
- Gently adjust the needle position or tube
- Apply more pressure to the tourniquet
Correct Answer: C) Gently adjust the needle position or tube
Explanation: If blood flow stops during venipuncture, first check that the tube is properly seated and creating adequate vacuum. If the tube is correct, gently adjust the needle position by slightly advancing, withdrawing, or rotating it. The needle may have moved against the vein wall or the bevel may be partially occluded. Avoid pushing too deep or making aggressive movements.
Question 8: What is the primary purpose of using an antiseptic before venipuncture?
- To numb the skin
- To make veins more visible
- To reduce the risk of infection
- To prevent bruising
Correct Answer: C) To reduce the risk of infection
Explanation: Antiseptic (typically 70% isopropyl alcohol) is used to reduce the microbial load on the skin surface, thereby minimizing the risk of introducing bacteria into the bloodstream during needle insertion. The antiseptic should be allowed to air dry completely before needle insertion to be most effective and to prevent stinging.
Question 9: Which of the following would most likely cause hemolysis in a blood specimen?
- Using a 21-gauge needle
- Mixing tubes gently
- Drawing blood too quickly through a small needle
- Allowing the antiseptic to dry
Correct Answer: C) Drawing blood too quickly through a small needle
Explanation: Drawing blood too quickly, especially through a small gauge needle (25-gauge or smaller), creates excessive suction that can damage red blood cells, causing hemolysis. This releases intracellular contents into the serum/plasma, which can interfere with many laboratory tests. Blood should flow smoothly into the tube without excessive force.
Question 10: What information must be included on a specimen label?
- Patient’s name only
- Patient’s name and date of birth
- Patient’s name, date of birth, and collection date/time
- Patient’s name, date of birth, collection date/time, and phlebotomist’s initials
Correct Answer: D) Patient’s name, date of birth, collection date/time, and phlebotomist’s initials
Explanation: Proper specimen labeling requires the patient’s full name, date of birth (or other unique identifier), collection date and time, and the phlebotomist’s initials or identification. This ensures proper patient identification, specimen tracking, and accountability. Labels should be applied immediately after collection and in the presence of the patient.
Question 11: When should gloves be changed during multiple patient collections?
- Only when visibly contaminated
- Between each patient
- Every hour
- Only at the end of the shift
Correct Answer: B) Between each patient
Explanation: Gloves must be changed between each patient to prevent cross-contamination and transmission of infectious agents. Even if gloves appear clean, they may be contaminated with microorganisms that are not visible. This is a fundamental infection control practice that protects both patients and healthcare workers.
Question 12: What is the correct procedure if you accidentally puncture an artery instead of a vein?
- Continue with the collection
- Remove the needle immediately and apply firm pressure for 5-10 minutes
- Insert the needle deeper
- Apply a tourniquet above the puncture site
Correct Answer: B) Remove the needle immediately and apply firm pressure for 5-10 minutes
Explanation: If an artery is accidentally punctured (indicated by bright red, pulsating blood), immediately remove the needle and apply firm, direct pressure for 5-10 minutes or until bleeding stops completely. Arterial punctures require longer pressure application due to higher blood pressure. Monitor the site for hematoma formation and document the incident.
Question 13: Which tube additive prevents blood clotting by binding calcium?
- Heparin
- EDTA
- Sodium fluoride
- Thrombin
Correct Answer: B) EDTA
Explanation: EDTA (Ethylenediaminetetraacetic acid) prevents blood clotting by chelating (binding) calcium ions, which are essential for the coagulation cascade. This makes EDTA tubes ideal for hematology tests where whole blood cell counts and morphology need to be preserved. EDTA tubes are typically lavender or purple-topped.
Question 14: What is the recommended gauge needle for routine adult venipuncture?
- 18-gauge
- 20-21 gauge
- 23-gauge
- 25-gauge
Correct Answer: B) 20-21 gauge
Explanation: A 20-21 gauge needle is recommended for routine adult venipuncture as it provides adequate blood flow while minimizing patient discomfort and hemolysis risk. Larger gauges (18) may cause unnecessary pain and tissue damage, while smaller gauges (23-25) may cause hemolysis due to excessive suction and slower blood flow.
Question 15: How should tubes be transported to the laboratory?
- In a vertical position at room temperature
- In a horizontal position on ice
- In a vertical position with appropriate temperature control
- Shaken vigorously during transport
Correct Answer: C) In a vertical position with appropriate temperature control
Explanation: Tubes should be transported in a vertical position (stopper up) to maintain the blood-additive interface and prevent contamination. Temperature control depends on the specific tests ordered – some require room temperature, others need refrigeration or protection from light. Tubes should never be shaken during transport as this can cause hemolysis or affect test results.